Nursing 471 A & P, Care for Pregnancy Dr. Jeannie Harper, PhD, RN

Uterus and Cervix Prepregnancy weight grams Term weight grams Out of true pelvis at 12 weeks At level of umbilicus at ~22 wks Rotates to right side Uterus, isthmus and cervix soften Uterine souffle arterial flow to placenta

Uterus and Cervix Funic souffle blood flowing through umbilical cord Chadwick’s sign bluish discoloration of cervix Goodell’s sign softening of cervical tip Hegar’s sign softening of lower uterine segment

Uterus and Cervix Ballottement ~ wks Quickening Multigravida weeks Primagravida 20 weeks Leukorrhea

Breasts Tender, tingling, fuller, heavier Nipples pigmented Montgomery’s tubercles Colostrum present at 16 weeks

Cardiovascular System Heart rate increases Cardiac output increases Blood volume increases by 40-50% RBC mass increases by 17% H and H decreases WBC count increases 2 nd and 3 rd trimester Clotting factors increase

Respiratory System Rate- no change or slight rise Total lung capacity-no change or slight decrease Oxygen consumption increases by 15-20%

Basal Metabolic Rate Varies Increases 15-20% at term

Renal System Renal pelvis and ureters dilate R side more affected Bladder capacity increases to 1500 mls r/t decreased bladder tone Urinary frequency and urgency 1 st and 3 rd trimesters

Renal System GFR and RPF increase Mild glucosuria in 20% of pregnant women Mild proteinura may be present Increased tubular reabsorption

Integumentary System Hyperpigmentation Chloasma Striae gravidarum Linea nigra Angiomas

Integumentary System Palmar erythema Pruritis Epulis Acne, oily skin

Musculoskeltal System Lordosis Waddling Pelvic joint relaxation Diastasis recti abdominus

Neurologic System Carpal tunnel syndrome Numbness/tingling of hands Lightheadness and syncope in early pregnancy

Gastrointestinal System Appetite fluctuates Morning sickness 1 st trimester Peristaltic activity decreases Taste changes Craving Hemorrhoids Hypertrophy of gums Ptyalism Pyrosis

Endocrine System HCG maintains corpus luteum Hormone levels increase Estrogen Progesterone Prolactin Relaxin Hormones decrease maternal ability to use insulin Estrogen Progesterone HCS/HPL Cortisol

Diagnosis of Pregnancy Subjective Symptoms Presumptive Objective Signs Presumptive Diagnostic Positive

Care of Pregnant Woman Initial Visit Interview  Obstetric & current pregnancy history  Medical and nutritional history  Family and social history Height, Weight, FHR Physical Exam Laboratory Tests  CBC, Bl type, Rh, VDRL/RPR, TB, HPV  GBS, HIV, GC, Chlamydia, Hep B, Toxo  Sickle cell, Pap Smear

Initial Visit (cont’d) Gestational age  EDC, EDD, EDB Noninvasive methods  LMP date (Nagele’s Rule)  Quickening date  Fundal height measurement Invasive methods  FHR by Doppler  Ultrasongraphy

Care of Pregnant Woman Subsequent Visits Monthly 1 st and 2 nd trimesters Every two weeks from week 28 Every week from week 36  Weight, BP, urinalysis  FHR, fetal movement, fundal hgt  1-hr GTT 1 st visit risk, 28 wks  28wks, 37 wks

Education Discomforts of pregnancy Signs of potential complications Recognizing preterm labor Physical activity/exercise Body mechanics

Education Employment Rest and relaxation Dental care Medications Substance abuse

Education Safety Travel Sexual counseling Nutrition

Quality versus Quantity Do not diet Fluid requirements 6-8 glasses per day Protein and iron critical Pica

Nutrition Additional caloric requirements Pregnancy 300 in 2 nd and 3 rd trimesters Lactation 500 calories

Weight Gain Based on Body Mass Index (BMI) Normal BMI11.5 – 16 kgs Underweight BMI12.5 – 18 kgs Overweight BMI7 – 11.5 kgs Obese BMIAt least 7 kgs Teens11.5 – 16 kgs

Adaptation to Pregnancy Maternal Accepting pregnancy Identifying with role of mother Reordering relationships Establishing relationship with unborn child Preparing for childbirth

Adaptation to Pregnancy Paternal Announcement phase Moratorium phase Focusing phase  Couvade Sibling

Special Pregnancy Care Cultural considerations Childbirth education Teen pregnancy